Cardiovascular morbidity and mortality after treatment of hyperthyroidism with either radioactive iodine or thyroidectomy

[helvella]

The choice between thyroidectomy and radioactive iodine (RAI) to treat hyperthyroidism has long been controversial. (Mind, we must not ignore the possibility of remaining long-term on anti-thyroid medication.) The possible side effects of RAI have been described, and discussed, at length over many years - both here in the HU Thyroid UK forum and elsewhere in both professional medical and patient-oriented forums. Side effects of RAI can include:

● A burning sensation or tenderness in the neck area

● Nausea and upset stomach (and rarely, vomiting)

● Swelling and tenderness of the salivary glands

● Taste changes (usually temporary)

● Dry mouth

● Reduction in tear production

● Slightly metallic taste in the mouth, even when not eating, or changes the way certain foods taste.

● Temporary or permanent decreases in blood cell counts can also occur.

● Any person receiving RAI treatment may have a slightly higher risk of developing certain other cancers in the future.

● Lower sperm counts or infertility.

● Irregular periods for up to a year after treatment. Many doctors recommend that women avoid becoming pregnant for at least 6 months to a year after treatment.

To this list, it appears we might need to add an increased risk of cardiovascular diseases.

Of those who have had RAI, were any of you informed of this possibility? (If it had not been known at the time, that might not indicate anyone did anything wrong.)

Thyroid. 2018 Jun 8. doi: 10.1089/thy.2017.0461. [Epub ahead of print]

Cardiovascular morbidity and mortality after treatment of hyperthyroidism with either radioactive iodine or thyroidectomy.

Ryodi E1, Metso S2, Huhtala H3, Välimäki M4, Auvinen A5, Jaatinen P6,7.

Author information

1 Tampere University Hospital, Heart Hospital, Tampere, Finland ; [e-mail].

2 Tampere University Hospital, Department of Internal Medicine, Tampere, Finland ; [e-mail].

3 Tampere University, School of Healt Sciences, Tampere, Finland ; [e-mail].

4 Helsinki University Central Hospital, Division of Endocrinology , Tehtaankatu 13 A 25 , Helsinki, Finland , 00140 ; [e-mail].

5 University of Tampere, Faculty of Social Sciences, Tampere, Finland ; [e-mail].

6 University of Tampere, School of Medicine , Building A , Tampere, Finland , FIN-33014.

7 Seinäjoki Central Hospital, Division of Internal Medicine, Seinäjoki, Finland ; [e-mail].

Abstract

BACKGROUND

Hyperthyroid patients remain at an increased risk of cardiovascular diseases (CVDs) after restoring euthyroidism. The impact of the different treatment modalities of hyperthyroidism on future CVD risk remains unclear. The aim of this paper is to assess cardiovascular morbidity and mortality in hyperthyroidism before and after the treatment, and to compare the effects of two different treatment modalities, radioactive iodine (RAI) and thyroid surgery.

METHODS

A comparative cohort study was conducted among 6,148 hyperthyroid patients treated either with RAI or thyroidectomy, and 18,432 age- and gender-matched controls. Firstly, hospitalizations due to CVDs prior to the treatment were analyzed. Secondly, the hazard ratios (HR) for any new hospitalization and mortality due to CVDs after the treatment were estimated among all the hyperthyroid patients compared to the age- and gender-matched controls and also in the RAI-treated patients compared to the thyroidectomy-treated patients. The results were adjusted for prevalent CVDs at the time of treatment.

RESULTS

Before the treatment of hyperthyroidism, hospitalizations due to all CVDs were more common in the hyperthyroid patients compared to the controls (OR 1.61, 95% CI 1.49-1.73). During the post-treatment follow-up, hospitalizations due to CVDs remained more frequent among the patients (HR 1.15, 95% CI 1.09-1.21), but there was no difference in CVD mortality (HR 0.93, 95% CI 0.84-1.03). Compared to the patients treated with thyroidectomy, the RAI-treated patients had a higher risk of hospitalization due to all CVDs (HR 1.17), and atrial fibrillation (HR 1.28), as well as a higher CVD mortality (HR 2.56). Yet, treatment with RAI resulting in hypothyroidism was not associated with increased CVD morbidity compared with thyroidectomy.

CONCLUSIONS

Hyperthyroidism increases the risk of CVD-related hospitalization, and the risk is sustained for up to two decades after treatment with RAI or surgery. Hyperthyroid patients treated with RAI remain at a higher CVD risk compared to patients treated with thyroidectomy. Hypothyroidism during the follow-up, however, predicts better cardiovascular outcome.

PMID: 29882483

DOI: 10.1089/thy.2017.0461

ncbi.nlm.nih.gov/pubmed/298...

[jimh111]

Interesting. Possibly those with RAI had different thyroid disorders or possibly RAI has some factor that increases risk. However, 'treatment with RAI resulting in hypothyroidism was not associated with increased CVD morbidity'. This is curious, does RAI affect the heart rendering it susceptible to thyroid hormone? I will try and get hold of the paper in a few months time when it may be more freely available.

[Valarian in reply to jimh111]

There seems to be a link between RAI and increased BMI. This could also have an impact.

[Airmed]

Very interesting helvella. Will show this paper to my doctor and endo. Saves blaming T3 for a change for any CVD.

[shambles]

It also does not mention that there is an increased chance of developing thyroid eye disease or causing further problems with eyes if like me you have they eye disease. Although can I add that surgery for removal also worsened my eyes!

[helvella Administrator in reply to shambles]

I take responsibility for the list which I quickly compiled from a number of sources, more as illustration than strictly a complete list. As you have rightly pointed out.

[Coastwalker]

Helvella, is radioactive iodine actually radiation ?

[helvella Administrator in reply to Coastwalker]

Radio-active iodine really, really is radio-active.

endocrineweb.com/conditions...

en.wikipedia.org/wiki/Iodin...

[Coastwalker in reply to helvella]

Thanks for the links helvella, I thought RAI was as you said 'really,' 'really' radiation, but wasn't 100% sure as I had never looked into it.

There was no mention in the studies done that Surgery, Radiation (and even Chemo,) can often lower vitamin B12 blood levels and that lowered vitamin B12 can cause higher levels of Homo cysteine, which in turn can cause cardiovascular diseases (not forgetting, these treatments can also bring on severe vitamin B12 problems, including death.)

Just a thought, it might be an idea for Hyperthyroid patients, before having Surgery and RAI to check their vitamin B12 blood levels and correct them before having Surgery and RAI.

[Snoddyoddbod]

I had RAI in 2016. I was told it was perfectly safe and I’d next one tablet and I’d feel wonderful after.

Two years later I feel worse that I did before treatment I take beta blockers as my heart rate bonkers without it. I take 150mcg of levothyroxin every day I have developed vertigo tinnitus bone problems skin problems

I regret having RAI every day!!!!

[Hidden in reply to Snoddyoddbod]

I hate to say, but someone else commented, natural thyroid hormones secreted from your own organ (that's how nature intended) and one made in a factory (presumably, synthetic version?) is not going to replace it and assume that your hormone balance would be optimum and importantly, the problem would simply go away. Endocrinology is probably one of the most irresponsible institutions in medicine. Long-term use of Levo could/might make the condition worse. RAI is a barbaric practice. Why do they still do it? Well, as always, it's their non-thinking, "not my problem" attitude. "Oh well, I won't get sued by those patients anyway, I did it because the guideline said so".

[Snoddyoddbod in reply to Hidden]

As you say barbaric. So why is it still being allowed to happen ?!

[Hidden]

I often feel that this isn't just about "Thyroid" is it? This type of serious irresponsibility by the Establishment keep occurring across all medical practices (if not all). But after a while, I/many of us have noticed this strong trend commented on other Hubs by those, who experienced the negligence and utter craziness. These patients have to continue living with the hazardous effects and long-term damage, which could have shortened their life or experienced the diminished health. "Do No Harm"? They seem to do the opposite as many posters had commented on different Hubs.

[Snoddyoddbod]

I had RAI in 2016. I was told it was perfectly safe and I’d next one tablet and I’d feel wonderful after.

Two years later I feel worse that I did before treatment I take beta blockers as my heart rate bonkers without it. I take 150mcg of levothyroxin every day I have developed vertigo tinnitus bone problems skin problems

I regret having RAI every day!!!!

[Hidden in reply to Snoddyoddbod]

The Establishment doesn't know what they are dealing with or they prefer to stick to their outdated "Gold Standard" leaving patients damaged. Likely the mixture of these petty things other than patient's care. Their priorities are simply distorted and never work for patients but mainly, Establishment being self-serving to maintain the old status quo as it is. Their belief system. "We are well protected by the legal team that we pay for monthly - we are safe, why should we do more or change things if all is going well with our career?" "Let's keep things going".

They are not gonna change things for patients unless advocacy groups apply the pressure for the change on the NHS/Establishment/Endo. The change may start to happen when people vocally show their concern in many ways.

[Snoddyoddbod in reply to Hidden]

There are 81k people on here suffering. How many more do they need before the start looking into it

[Coastwalker in reply to Snoddyoddbod]

Vertigo, tinnitus and bone problems are strongly linked to vitamin B12 deficiency Snoddyoddbod.

[Hidden]

Well, they rarely care as they are well protected. They would start to care when they realised their cherished procedure (their cash cow to keep their bank accounts well nourished ) would suddenly stop due to its potential serious faults/damage. They wouldn't want to go out of pocket, that's what they would worry about if I'm frank.

[bantam12]

At risk of getting shot down in flames dare I say that many people have no problems with RAI either during or after treatment.

Personally it was the best decision for me seeing as surgery had already failed, I had no side effects whatsoever apart from being tired due to going hypo very quickly and for me that's preferable to being hyper 😁

[helvella Administrator in reply to bantam12]

You are absolutely NOT going to get shot down in flames by me. You are completely right to report your experience - whether it agrees with others or not.

My suspicion is that a combination of the appropriate choice of patient, correct dosing, etc., can produce a good result. There are, though, questions about all these factors and whether existing protocols are able to work as well as would be hoped.

RAI might stop being available, at least for a while, depending on how brexit and possible leaving of Euratom are handled.

[Valarian]

No shooting from me Bantam12.

While I hate the idea of losing a blameless and healthy thyroid, there are people whose Graves’ Disease cannot be controlled either with a relatively short period of high/moderate anti-thyroid therapy, or low-dose , long- term anti-thyroid therapy.

As someone who has yet to see my thyroid levels remain consistently within range on anything less than 20mg Carbimazole/day, it’s becoming pretty clear that sometimes there may not be a good option.

I’m very glad the people who have had bad experiences speak out. However, it does worry me a bit that we probably don’t get a balanced view here, because those whose treatment has been successful have little reason to hang out on this forum.

I guess this is a plea to everyone having RAI or Thyroid surgery to consider paying us a visit once a year, perhaps after getting their annual test results, and updating us on their progress .

What we really need are new treatment options.